Intraoperative endoscopy of the biliary tract

This is a prospective series of 328 operations for biliary stone disease in 326 consecutive patients. The overall operative mortality was 0.6%. Routine operative cholangiography was utilized during cholecystectomy, and this identified 19 patients (5.9%) with silent common bile duct stones. Common bile duct explorations were positive in 62 of 74 operations (83.8%). Biliary endoscopy was routinely performed during bile duct exploration. Unsuspected retained common duct stones were discovered postoperatively in 4.5% of these patients. Biliary endoscopy proved essential in the management of 18 patients with radiographically demonstrated distal bile duct obstruction. With patency confirmed by endoscopy, inappropriate duodenotomy and sphincter ablation were avoided in each of these 18 patients.